Browsing by Author "Bhusal, Khem Raj"
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Publication Aspirin Desensitization and Percutaneous Coronary Intervention in a Patient with Aspirin Hypersensitivity and Acute Coronary Syndrome: A Case Report(Nepal Medical Association, 2024) Acharya, Suman; Gyawali, Siddinath; Kharel, Sanjeev; Upreti, Dinesh; Bhusal, Khem Raj; Maharjan, Silvia; Shrestha, Hemanta; Gajurel, Ratna ManiAbstract Hypersensitivity to aspirin is rare disorder occurring in 1.88% of the patients. Aspirin-hypersensitive patients requiring single antiplatelet agent may be treated with clopidogrel, an alternative antiplatelet agent. However, aspirin desensitization is more cost-effective than the usage of clopidogrel in these patients. Furthermore, aspirin desensitization is of greater value in patients requiring dual antiplatelet therapy, for example following procedures like percutaneous transluminal coronary angioplasty (PTCA) instead of using non-aspirin-based combinations. Herein, we report a 74-year-old hypertensive male presented with features of acute coronary syndrome and planned for percutaneous transluminal coronary angioplasty of RCA followed by dual antiplatelet therapy. Since he had aspirin allergy, desensitization was done using rapid desensitization protocol for which he responded well. This case highlights the importance of aspirin-desensitization in patients with aspirin allergy instead of choosing non-aspirin based antiplatelet agents.Publication Impact of Thrombus Burden in Patients with Acute Coronary Syndrome during the Hospital Stay: A Cross-Sectional Study at a Tertiary Center in Nepal(Institute of Medicine, Tribhuvan University, 2025) Bhusal, Khem Raj; Shrestha, Hemant; Devkota, Surya; Thapa, Sanjeev; Manandhar, Bhawani; Khanal, Raja Ram; Shakya, Smriti; Thapa, Shovit; Jha, Suchit; Miya, Madeena; Sah, Sangam; Upadhayaya, Prajjwal; Gajurel, Ratna ManiAbstract: Introduction Acute coronary syndrome (ACS) is the leading cardiovascular (CV) cause of mortality and necessitates prompt diagnosis and treatment. Luminal thrombus secondary to coronary plaque rupture is considered as the underlying mechanism for ACS. Intracoronary thrombus burden was a strong predictor for adverse outcomes including stent thrombosis, myocardial re-infarction, and mortality. Methods This study was done in consecutively taken 72 patients presenting with acute coronary syndrome. Angiographic grading of intracoronary thrombus was done according to TIMI thrombus grading. Information on Cardiovascular risk factors and comorbidities was obtained and analysis was done with respect to Thrombus Grade. Adverse cardiovascular outcomes during hospital stay, length of hospital stay and in-hospital mortality were analyzed with respect to thrombus grade. Results Among 72 patients studied, the mean age was 58.93 (± 14.22 years) ranging from 30 years to 91 years. Males were 36.1% while 63.9% were females. Regarding the comorbidities, 62.5% were Hypertensive, 34.7% were Diabetic, 6.9% had hypothyroidism, 2.8% had chronic kidney disease and 5.6% had chronic obstructive pulmonary diseas, 38.9% were active smokers, 15.3% were former smokers, 34.7% were alcohol consumer, 5.6% were tobacco consumer and 1.4% were substance abuser. Among the participants, 6.9% had prior history of MI and 4.2% had prior history of stroke. High thrombus burden was associated with longer duration of hospital stay (p-value=0.026). Conclusion High Thrombus burden was significantly associated with longer duration of hospital stay because of being sicker due to higher cardiovascular events in high thrombus group. Cardiovascular complications were significantly higher in high thrombus burden group.